Incidence of postoperative complications in patellar fractures related to different methods of osteosynthesis procedures - a retrospective cohort study.

BACKGROUND: Patellar fractures have a comparatively low incidence compared to all fracture frequencies of the musculoskeletal system. However, surgical management is crucial to prevent postoperative complications that affect the knee joint. The purpose of the present study was to evaluate the incidence of postoperative complications and onset of postoperative osteoarthritis related to the chosen technique of patellar fracture management. METHODS: In a retrospective cohort study consecutive managed, isolated patella fractures were reviewed for demographic data, trauma mechanism, patella fracture type, fixation technique and postoperative complications. The results were documented radiographically and clinically and analysed statistically. The reporting followed the STROBE guidelines. RESULTS: A total of 112 patients were eligible for data evaluation. Surgical management of comminuted patellar fractures with small fragment screws showed significant fewer postoperative complications compared to other fixation techniques (8%, p < 0.043). The incidence of posttraumatic infection was significantly higher following the hybrid fixation technique with cannulated screws and tension wire than following the other analysed techniques (p = 0.024). No postoperative wound infection was observed after screw fixation or locking plate fixation. Symptomatic hardware was most frequently seen after tension-band fixation. Onset of posttraumatic osteoarthritis was most often found after the hybrid fixation technique (55%). CONCLUSION: Surgical management of patellar fractures remains crucial but fracture fixation using plating systems or small fragment screws is least associated with postoperative complications. TRIAL REGISTRATION: Trial registration number (DRKS):00027894.

Ligamentous healing potential of the acromioclavicular ligament following acute anatomical reconstruction.

BACKGROUND: Horizontal instability following acute acromioclavicular joint (ACJ) reconstruction still occurs with a high prevalence. Although the human acromioclavicular ligament complex (ACLC) represents the major horizontal ACJ stabilizer, experimental studies on healing characteristics are lacking. Therefore, the purpose of this histological study was to investigate the healing potential of the ACLC following acute anatomical reconstruction METHODS: In this prospective clinical-experimental study, 28 ACLC biopsies were performed in patients with complete ACJ dislocations (Rockwood type 4 or 5) during acute hook plate stabilization (IG: implantation group; n = 14) and hook plate removal (EG: explantation group; n = 14). Histological analyses included Giemsa staining, polarized light microscopy and immunostaining against CD68, αSMA and collagen type I and type III. Histomorphological evaluation entailed cell counts, collagen expression score, ligament tissue maturity index (LTMI) and descriptive analysis of specific ligamentous structures. Statistics consisted of nonparametric Mann-Whitney U tests and a level of significance of P < .05. RESULTS: Total cell counts (cells/mm2 1491 ± 296 vs. 635 ± 430; P < 0.001) and collagen III expression (3.22 ± 0.22 vs. 1.78 ± 0.41; P < 0.001) were higher in EG compared to IG. Inversely αSMA + (11 ± 9 vs. 179 ± 186; P < 0.001) and CD68 + cell counts (56 ± 20 vs. 100 ± 57; P 0.009) were significantly lower in the EG. The EG revealed a comparable reorientation of ligamentous structures. Consistently, ACLC samples of the EG (21.6 ± 2.4) displayed a high total but differently composed LTMI score (IG: 24.5 ± 1.2; P < 0.001). CONCLUSIONS: This experimental study proved the ligamentous healing potential of the human ACLC following acute anatomical reconstruction. Histomorphologically, the ACLC reliably showed a ligamentous state of healing at a mean of about 12 weeks after surgery. However, processes of ligamentous remodeling were still evident. These experimental findings support recent clinical data showing superior horizontal ACJ stability with additional AC stabilization in the context of acute ACJ reconstruction. Though, prospective clinical and biomechanical studies are warranted to evaluate influencing factors on ACLC healing and potential impacts of acute ACLC repair on clinical outcome. STUDY TYPE: Controlled Laboratory Study.

The tissue-renin-angiotensin-system of the human intervertebral disc.

Symptomatic intervertebral disc (IVD) degeneration accounts for significant socioeconomic burden. Recently, the expression of the tissue renin-angiotensin system (tRAS) in rat and bovine IVD was demonstrated. The major effector of tRAS is angiotensin II (AngII), which participates in proinflammatory pathways. The present study investigated the expression of tRAS in human IVDs, and the correlation between tRAS, inflammation and IVD degeneration. Human IVD tissue was collected during spine surgery and distributed according to principal diagnosis. Gene expression of tRAS components, proinflammatory and catabolic markers in the IVD tissue was assessed. Hydroxyproline (OHP) and glycosaminoglycan (GAG) content in the IVD tissue were determined. Tissue distribution of tRAS components was investigated by immunohistochemistry. Gene expression of tRAS components such as angiotensin-converting enzyme (ACE), Ang II receptor type 2 (AGTR2), angiotensinogen (AGT) and cathepsin D (CTSD) was confirmed in human IVDs. IVD samples that expressed tRAS components (n = 21) revealed significantly higher expression levels of interleukin 6 (IL-6), tumour necrosis factor α (TNF-α), a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 4 and 5 compared to tRAS-negative samples (n = 37). Within tRAS-positive samples, AGT, matrix-metalloproteinases 13 and 3, IL-1, IL-6 and IL-8 were more highly expressed in traumatic compared to degenerated IVDs. Total GAG/DNA content of non-tRAS expressing IVD tissue was significantly higher compared to tRAS positive tissue. Immunohistochemistry confirmed the presence of AngII in the human IVD. The present study identified the existence of tRAS in the human IVD and suggested a correlation between tRAS expression, inflammation and ultimately IVD degeneration.

[Primary fracture protheses and reverse shoulder arthroplasty in complex humeral head fractures : An alternative to joint-preserving osteosynthesis?] / Primäre Frakturprothese und inverse Schulterprothese bei komplexer Humeruskopffraktur : Eine Alternative zur gelenkerhaltenden Osteosynthese?

BACKGROUND: The surgical management of complex humeral head fractures has adapted dynamically over the course of the last decade. The primary use of reverse shoulder arthroplasty in elderly patients has gained in relevance due to promising short and middle-term results. Long-term results, however, are still pending. The appliance of anatomical hemiarthroplasty, on the other hand, has lost in significance in favour of osteosynthesis and reverse shoulder arthroplasty. INDICATIONS: This review article follows the question as to under which circumstances primary fracture arthroplasty reflects an alternative or even a preference to joint-preserving osteosynthesis in the treatment of complex proximal humeral fractures. It also specifies spectrums of indications for anatomical hemiarthroplasty and reverse shoulder arthroplasty.

Dynamics of the population structure and genetic variability within Iranian isolates of grapevine fanleaf virus: evidence for polyphyletic origin.

To determine the genetic diversity and population structure of grapevine fanleaf virus (GFLV), the complete nucleotide sequence of the coat protein gene of 41 isolates from different regions in Iran was determined. Phylogenetic analyses of these isolates together with those available in the GenBank revealed two evolutionary divergent lineages, designated GFLV-G and GFLV-Ir that reflect origin of the isolates. Analysis of the genetic variability in the coat protein of these isolates revealed 37 genotype groups in GFLV population. Analyses indicate that GFLV-G and GFLV-Ir clades are significantly differentiated populations of GFLV. Also, geographical subpopulations of the virus in Iran were completely distinct from each other. Examination of nonsynonymous/synonymous nucleotide diversity showed that the CP gene has been under purifying selection. The neutrality tests indicate balancing selection operating within isolates of the northwest of Iran and purifying selection within the other populations.

[Influencing factors and complications in open treatment of acute anterior glenoid rim fractures]. / Einflussfaktoren und Komplikationen bei offener Versorgung akuter anteriorer Glenoidrandfrakturen.

BACKGROUND: The aim of this comparative study was to evaluate the clinical radiological outcome after open treatment of acute anterior glenoid rim fractures and to analyze the influencing factors and complications. PATIENTS AND METHODS: The study included 26 patients with an average age of 51.6 years (range 27-71 years) at surgery. The mean period of follow-up was 5.1 years (range 2.0-11.1 years). The average extent of glenoid fracture involvement was 25.5 % (range 18-35%) and three fixation techniques were applied: 1) bioresorbable pins (n = 16), 2) small fragment screws (n = 5) and 3) bioresorbable suture anchors (n = 5). RESULTS: The mean score values were 80.3 points for the absolute Constant score, 87.6 points for the normalized Constant score, 88.7 points for the Rowe score, 17.4 points for the Oxford shoulder score, 10.3 points for the simple shoulder test, 13.0 points for the shoulder pain and disability index and 81.5 % for the subjective shoulder value. The fixation technique did not show a significant influence; however, multi-fragment fractures were associated with a significantly inferior absolute (73 vs. 87 points, p = 0.022) and normalized Constant scores (81 vs. 94 points, p = 0.019). Subscapularis insufficiency with internal rotation deficit was found in 10 (39 %) patients and posttraumatic osteoarthritis occurred in 6 (23 %) patients. CONCLUSION: Open fixation yielded good or excellent shoulder function in 20 out of the 26 (77 %) patients and the clinical outcome primarily depended on the underlying type of fracture. Significantly inferior outcomes should be expected in patients with multi-fragment fractures. The main complications were subscapularis insufficiency and posttraumatic osteoarthritis.

Biomechanical investigation of a minimally invasive posterior spine stabilization system in comparison to the Universal Spinal System (USS).

BACKGROUND: Although minimally invasive posterior spine implant systems have been introduced, clinical studies reported on reduced quality of spinal column realignment due to correction loss. The aim of this study was to compare biomechanically two minimally invasive spine stabilization systems versus the Universal Spine Stabilization system (USS). METHODS: Three groups with 5 specimens each and 2 foam bars per specimen were instrumented with USS (Group 1) or a minimally invasive posterior spine stabilization system with either polyaxial (Group 2) or monoaxial (Group 3) screws. Mechanical testing was performed under quasi-static ramp loading in axial compression and torsion, followed by destructive cyclic loading run under axial compression at constant amplitude and then with progressively increasing amplitude until construct failure. Bending construct stiffness, torsional stiffness and cycles to failure were investigated. RESULTS: Initial bending stiffness was highest in Group 3, followed by Group 2 and Group 1, without any significant differences between the groups. A significant increase in bending stiffness after 20'000 cycles was observed in Group 1 (p = 0.002) and Group 2 (p = 0.001), but not in Group 3, though the secondary bending stiffness showed no significant differences between the groups. Initial and secondary torsional stiffness was highest in Group 1, followed by Group 3 and Group 2, with significant differences between all groups (p ≤ 0.047). A significant increase in initial torsional stiffness after 20'000 cycles was observed in Group 2 (p = 0.017) and 3 (p = 0.013), but not in Group 1. The highest number of cycles to failure was detected in Group 1, followed by Group 3 and Group 2. This parameter was significantly different between Group 1 and Group 2 (p = 0.001), between Group 2 and Group 3 (p = 0.002), but not between Group 1 and Group 3. CONCLUSIONS: These findings quantify the correction loss for minimally invasive spine implant systems and imply that unstable spine fractures might benefit from stabilization with conventional implants like the USS.

Application of human amniotic membrane in canine penile tunica albuginea defect: first step toward an innovating new method for treatment of Peyronie's disease.

PURPOSES: To evaluate the efficacy of human amniotic membrane (AM) grafting in the canine penile tunica albuginea defect; we developed an animal model as the first step toward an innovating new method for the treatment of Peyronie's disease, penile cancers, and congenital deformities of the penis. MATERIAL AND METHODS: From August to September 2011, ten healthy male dogs were selected. A rhomboid incision about 3 x 2 cm over the tunica albuginea and its overlying squamous epithelium was made and then excised. The amniotic membrane was folded twice on itself and grafted on the defect. After 8 weeks, artificial erection was made for 5 dogs and for the other 5 dogs after 12 weeks. After artificial erection, partial penectomy was done and histopathological evaluation was performed on the grafts. RESULTS: Artificial erection performed successfully in all of the dogs. No infection or any other complication was seen. Histopathological examination showed complete re-epithelialization with squamous epithelium and collagen fiber deposition. Also, no dysplasia was seen. CONCLUSIONS: The amniotic membrane can be used as a suitable substitution for tunica albuginea. It is safe, inexpensive, biodegradable, and available and may be used for the treatment of Peyronie ' s disease, penile cancers, congenital penile deformities, and penile reconstructive surgery.

Anatomical assessment of iliac crest graft size for anterior spondylodesis.

Standard procedure for monosegmental anterior spondylodesis often combines anterior stabilization with autologous iliac crest graft. Recent publications defined a minimum size of the graft as a technical specification for this procedure. The cross sectional area of the graft to be transplanted should be at least 23.9% of the cross sectional area of the vertebral bodies to be fused. We investigated whether the required minimum size of autologous graft, as identified both experimentally and clinically, is compatible with the anatomical conditions in central european patients. Computed tomography scans (n = 348) of polytraumatized patients were obtained in the course of initial diagnosis. The scans were evaluated for vertebral body size and the possible size of autologous bone graft in the region of the anterior superior iliac crest. The evaluation of 348 CT scans demonstrated that 95% of the quantified iliac crest grafts would achieve the size recommended for anterior spinal fusion between T10 and T12. In 90% of all cases the planned iliac crest graft exceeded the size limit of 23,9% between concerning the endplates T10 and L2. In 85% the planned iliac crest graft exceeded the size limit of 23,9% between T10 and L3. The recommendation to take this value into account for monosegmental anterior spondylodesis should gain in importance in clinical practice.

Tears of the rotator cuff. Causes--diagnosis--treatment.

Rotator cuff ruptures are the most common degenerative tendon injury and occur mainly in older patients as multifactorial disorders manifesting the main symptoms of pain and restricted range of motion. Thorough clinical examination of the shoulder includes testing the function of the rotator cuff and leads to a tentative clinical diagnosis that is the prerequisite for diagnostic imaging procedures. Sonography of the shoulder gives rapid access to a very good sensitive overview of the rotator cuff. Conventional radiological imaging permits differential diagnosis since a reduced acromiohumeral interval is understood as a direct sign of rotator cuff rupture. The gold standard in imaging diagnostics is MRI because it not only delivers images of rotator cuff defects, but also permits interpretation of degenerative changes in the musculature. Significant pain relief can be achieved by conservative therapy such as analgesia, manual therapy and physiotherapeutic exercises and leads to improvements in the active range of motion. Persistent pain or progressive pain during conservative therapy are indications for surgical intervention. Arthroscopy-assisted treatment is tissue friendlier than open surgery and is today considered the standard for surgical treatment of rotator cuff rupture because of higher patient acceptance. Recent studies report that surgical rotator cuff repair leads to significant improvement in function, pain relief, and greater patient satisfaction. The principles of postoperative care after surgical rotator cuff repair are immobilization and gradual loading with passive and active exercises.

Whitefly-mediated transmission of cotton leaf curl Multan betasatellite: evidence for betasatellite encapsidation in coat protein of helper begomoviruses.

Cotton leaf curl Multan betasatellite (CLCuMB) is responsible for symptom expression of a devastating disease of cotton in the Indian subcontinent. CLCuMB depends on helper virus replication-associated protein for its replication and on viral coat protein (CP) for its encapsidation. However, no direct evidence of encapsidation of CLCuMB in viral CP has been available. In the present study, non-viruliferous whiteflies were placed on tomato plants that had been agroinoculated with infectious clones of an Iranian isolate of tomato yellow leaf curl virus (TYLCV-[Ab]) and CLCuMB for an acquisition access period of 72 h and then transferred to healthy tomato seedlings at the 3- to 4-leaf stage. Typical symptoms of TYLCV-[Ab] appeared on inoculated seedlings 30-45 days post-inoculation. The presence of TYLCV-[Ab] and CLCuMB DNAs in symptomatic test plants and viruliferous whiteflies was confirmed by PCR analysis using specific primers and DIG Southern blotting. Furthermore, the possibility of CLCuMB DNA encapsidation in TYLCV-[Ab] CP within infected plants was examined by immunocapture PCR. The results showed that CLCuMB DNA was encapsidated in TYLCV-[Ab] CP. Whitefly-mediated transmission of CLCuMB in the presence of helper virus is additional evidence for encapsidation of CLCuMB by TYLCV-[Ab] CP.

Geographic distribution and phylogenetic analysis of cucurbit yellow stunting disorder virus in Iran.

Cucurbit yellow stunting disorder virus (CYSDV) is a destructive virus of cucurbits in Iran. During 2008-2012 growing seasons a total of 366 cucurbit samples including melon, cucumber, snakemelon and squash with typical symptoms of CYSDV infection were collected from ten Provinces in Iran. They were screened by ELISA and the infectivity of ELISA-positive samples was confirmed by RT-PCR. The results showed that 309 out of 366 samples were infected by CYSDV. The virus was present in many areas of southern and central Provinces of the country. Analyses of nucleotide and amino acid sequences of the CYSDV coat protein (CP) showed that Iranian isolates form a cluster and were placed in the Eastern subgroup of CYSDV. The Eastern subgroup of CYSDV was divided into two diverged subgroups including Iranian isolates and Saudi Arabian isolates. The identity among Iranian isolates was more than 99 %. Estimation of genetic distances showed that the number of nucleotide and amino acid substitutions per site from averaging overall Iranian sequence pairs were 0.004 and 0.008, respectively. Phylogenetic analyses and the estimation of genetic distance indicated that Iranian isolates have low genetic diversity.

[Radiological comparison between two procedures for ventral spondylodesis: autologous iliac crest bone graft vs bovine bone graft]. / Radiologischer Vergleich zweier Verfahren zur ventralen Spondylodese: Autologer trikortikaler Beckenkammspan vs. boviner Spongiosablock.

BACKGROUND: The objective of this study was the radiological evaluation of osseous integration of autologous iliac crest graft and bovine bone graft after spondylodesis based on a standardized score. MATERIAL AND METHODS: Spondylodesis was performed on 18 sheep, divided into 2 groups, 1 with an autologous iliac crest graft and the other with a bovine bone graft. Computed tomography was performed 12 and 24 weeks postoperatively. The osseous integration was assessed by the Tübinger Score. RESULTS: The evaluation of the CT scans demonstrated a significantly better osseous integration of the autologous iliac crest graft compared to the bovine bone graft. CONCLUSIONS: Based on our results, the bovine bone graft as a transplant for spondylodesis is inadvisable.

Treatment of Large Cartilage Defects in the Knee by Hydrogel-Based Autologous Chondrocyte Implantation: Two-Year Results of a Prospective, Multicenter, Single-Arm Phase III Trial.

OBJECTIVE: To evaluate the clinical outcome of a hydrogel-based autologous chondrocyte implantation (ACI) for large articular cartilage defects in the knee joint. DESIGN: Prospective, multicenter, single-arm, phase III clinical trial. ACI was performed in 100 patients with focal full-thickness cartilage defects ranging from 4 to 12 cm2 in size. The primary outcome measure was the responder rate at 2 years using the Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS: Two years after ACI treatment, 93% of patients were KOOS responders having improved by ≥10 points compared with their pre-operative level. The primary endpoint of the study was met and demonstrated that the KOOS response rate is markedly greater than 40% with a lower 95% CI (confidence interval) of 86.1, more than twice the pre-specified no-effect level. KOOS improvement (least squares mean) was 42.0 ± 1.8 points (95% CI between 38.4 and 45.7). Mean changes from baseline were significant in the overall KOOS and in all 5 KOOS subscores from Month 3 (first measurement) to Month 24 (inclusive) (P < 0.0001). The mean MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score after 24 months reached 80.0 points (95% CI: 70.0-90.0 points) and 92.1 points in lesions ≤ 5 cm2. CONCLUSIONS: Overall, hydrogel-based ACI proved to be a valuable treatment option for patients with large cartilage defects in the knee as demonstrated by early, statistically significant, and clinically meaningful improvement up to 2 years follow-up. Parallel to the clinical improvements, MRI analyses suggested increasing maturation, re-organization, and integration of the repair tissue. TRIAL REGISTRATION: NCT03319797; EudraCT No.: 2016-002817-22.

Witches'-Broom Disease of Lime Affects Seed Germination and Seedling Growth But Is Not Seed Transmissible.

Witches'-broom disease of lime (WBDL), caused by 'Candidatus Phytoplasma aurantifolia', has devastated many Mexican lime orchards and is currently a threat to lime production in neighboring provinces of southern Iran. Several reports have suggested transmission and spread of WBDL phytoplasma through the seed of infected plants. In the present study, claims of seed transmission of this phytoplasma were examined. Fruit were collected from infected trees in the infested areas of Minab (Hormozgan Province) and from symptomless trees in noninfested areas. Lime seed from symptomless and witches'-broom-affected trees were sown in separate beds in an insect-proof screenhouse and the resulting seedlings were examined for phytoplasmal infection. Leaf, stem, and root samples were collected from both groups of seedlings every 3 months for 2 years and tested for WBDL phytoplasma using direct and nested polymerase chain reaction (PCR). Repeated PCR tests on the seedlings did not reveal the presence of phytoplasmal DNA. Likewise, symptoms of the disease were not observed on these seedlings after 2 years. PCR assays detected the phytoplasma in coats of some seed from infected trees; however, no excised embryos were positive for the phytoplasma. All positive PCR results were confirmed by restriction fragment length polymorphism assay. One-year-old seedlings derived from seed of noninfected plants appeared more vigorous in terms of height, number of leaves, and fresh weight of shoot compared with those from infected trees. The germination percentage, mean daily germination, peak value, and germination value were significantly higher for seed of fruit from noninfected trees and seed from fruit on asymptomatic branches of infected trees than those from fruit on symptomatic branches of infected trees.

[Traumatic injuries of the sternoclavicular joint]. / Traumatische Verletzungen des Sternoklavikulargelenks.

Traumatic injuries of the sternoclavicular joint occur rarely and are mainly caused by an indirect trauma mechanism with high kinetic energy. Anterior dislocation is much more common than posterior dislocation, which may be associated with life-threatening injuries. The CT scan is the diagnostic tool of choice for accurate assessment of the injury and coexisting pathologies. The primary goal in anterior and posterior dislocations is an early closed reduction. In cases of redislocation after closed reduction of an anterior dislocation we recommend primary joint reconstruction on the basis of an individual therapeutic concept. Posterior dislocations often cannot be reduced by closed means. Then open reconstruction and stabilization are performed. Chronic instabilities should only be addressed surgically in cases of persistent pain and/or functional deficit. Resection of the medial clavicula represents an effective treatment option in post-traumatic sternoclavicular joint arthritis provided that the costoclavicular ligaments are intact or will be reconstructed during surgery. Physeal injuries of the medial clavicle can occur until an approximate age of 25. Closed reduction of dislocated physeal injuries is attempted. After reposition non-operative treatment in general leads to a good functional outcome. Posteriorly dislocated physeal injuries often cannot be reduced by closed means. In these cases good function can be expected after open stabilization.

[Limitations of reconstruction - prostheses]. / Grenzen der Rekonstruktion - Prothesen.

Fractures of the proximal humerus are common, particularly seen in elderly, female patients. Using open reduction and internal fixation good clinical results can be achieved in general. But even today not every problem has been solved in the treatment of proximal humeral fractures. Varus displaced fractures are particularly challenging, especially when the medial column is destroyed. Anatomical reduction of the humeral head and medial bone contact are crucial for a good surgical outcome. Otherwise a secondary varus collapse and/or an implant failure are predictable. Further challenges are the intra-articular fracture patterns, as well as fractures with an initial ischemic humeral head. The indications for prosthetic replacement are always present if an initially stable internal fixation could not be achieved. The reverse fracture prostheses represent an increasingly common treatment option; however, the indication should be reserved for the elderly over 75 years.

Fractures of the scapula.

The scapula connects the arm with the chest wall and is therefore of great importance for a free range of shoulder of motion. For a long-term scapular fractures had been treated predominantly conservative. However, clinical studies of the past decades revealed that some fracture patterns deserve operative treatment to prevent unfavorable functional outcome and chronic state of pain. Scapular fractures are predominantly acquired during high-energy trauma and these patients' presents with a mean of 3.9 associated injuries in the emergency department. Injuries to the head, chest and ipsilateral upper extremity are most common. As some of these injuries are possibly life threatening they are treated first. Scapular fractures are only very seldom surgical emergencies. Therefore they are treated during the phase of reconvalescence in polytraumatized patients. Decision-making should be based on a thoroughgoing diagnostics, including conventional x-rays and a CT-scan, epically in cases of glenoid neck or cavity fractures. All fracture patterns should be identified to there full extend and put into the context of the scapular suspensory complex. The OTA lately presented a new and comprehensive system for classification of the scapular fractures. It is divided in two levels. Level one for the general orthopedic or trauma surgeon and Level two for the advanced upper Extremity or Shoulder surgeon. This classification scheme allows an easy access to understanding of the severity and prognostics of scapular fractures. As a general guideline surgery is indicated if a double disruption of the Scapula suspensory system, a relevant malposition or dysintegrity of the glenoid (articular surface) or a displacement of the lateral column is present.

Characterization of a filamentous virus from Bermuda grass and its molecular, serological and biological comparison with Spartina mottle virus.

Bermuda grass with mosaic symptoms have been found in many parts of Iran. No serological correlation was observed between two isolates of this filamentous virus and any of the members of the family Potyviridae that were tested. Aphid transmission was demonstrated at low efficiency for isolates of this virus, whereas no transmission through seed was observed. A DNA fragment corresponding to the 3' end of the viral genome of these two isolates from Iran and one isolate from Italy was amplified and sequenced. A BLAST search showed that these isolates are more closely related to Spartina mottle virus (SpMV) than to any other virus in the family Potyviridae. Specific serological assays confirmed the phylogenetic analysis. Sequence and phylogenetic analysis suggested that these isolates could be considered as divergent strains of SpMV in the proposed genus Sparmovirus.

Molecular characterization of the plant virus genus Ourmiavirus and evidence of inter-kingdom reassortment of viral genome segments as its possible route of origin.

Ourmia melon virus (OuMV), Epirus cherry virus (EpCV) and Cassava virus C (CsVC) are three species placed in the genus Ourmiavirus. We cloned and sequenced their RNA genomes. The sizes of the three genomic RNAs of OuMV, the type member of the genus, were 2814, 1064 and 974 nt and each had one open reading frame. RNA1 potentially encoded a 97.5 kDa protein carrying the GDD motif typical of RNA-dependent RNA polymerases (RdRps). The putative RdRps of ourmiaviruses are distantly related to known viral RdRps, with the closest similarity and phylogenetic affinity observed with fungal viruses of the genus Narnaviridae. RNA2 encoded a 31.6 kDa protein which, expressed in bacteria as a His-tag fusion protein and in plants through agroinfiltration, reacted specifically with antibodies made against tubular structures found in the cytoplasm. The ORF2 product is significantly similar to movement proteins of the genus Tombusviridae, and phylogenetic analysis supported this evolutionary relationship. The product of OuMV ORF3 is a 23.8 kDa protein. This protein was also expressed in bacteria and plants, and reacted specifically with antisera against the OuMV coat protein. The sequence of the ORF3 protein showed limited but significant similarity to capsid proteins of several plant and animal viruses, although phylogenetic analysis failed to reveal its most likely origin. Taken together, these results indicate that ourmiaviruses comprise a unique group of plant viruses that might have evolved by reassortment of genomic segments of RNA viruses infecting hosts belonging to different eukaryotic kingdoms, in particular, fungi and plants.